Despite the increasing incidence of renal trauma, the management of major renal injuries remains controversial. We reviewed our experience to identify changes in renal injury management and to clarify the usefulness of nonsurgical management. We retrospectively analyzed the charts and films of 128 patients admitted to our hospital for renal injury from March 2003 to April 2010. We classified the patients into three groups according to treatment methods: conservative treatment, surgical treatment, and percutaneous embolization, and made comparisons between the first (Group A) and last (Group B) 64 patients. Patients were 97 males (75.8%) and 31 females (24.2%) with a mean age of 36.0 years. The main cause of injury was related to traffic accidents in 62 cases (48.4%), and the most common associated injury was hemoperitoneum in 31 cases (24.2%). According to radiologic and operative findings, the cases were classified as follows: grade I in 14 cases (10.9%), grade II in 16 cases (12.5%), grade III in 36 cases (28.1%), grade IV in 48 cases (37.5%), and grade V in 15 cases (11.7%). All patients with low grade (grade I, II) and grade V renal injury were treated with conservative therapy and operation, respectively, and there were no differences between Group A and Group B. Grade III and IV renal injury cases showed some difference in management between the two groups, however. In Group B compared with Group A, all grade III renal injury patients were successfully treated with nonoperative management (p=0.171). The percutaneous embolization rate was increased (Group A: 12.0%, Group B: 21.7%), and the surgical treatment rate was decreased (Group A: 16.0%, Group B: 4.3%) in patients with grade IV renal injuries (p=0.325). Nonoperative management was successfully performed even in patients with grade III and IV renal injury; therefore, it will be considered as the first treatment of choice in most high-grade renal injuries except for grade V renal injuries.